院外心脏骤停后生存的性别效应：一项基于韩国国家心脏骤停登记处的全国性、基于人群的病例对照倾向评分匹配研究。
Gender effect in survival after out-of-hospital cardiac arrest: A nationwide, population-based, case-control propensity score matched study based Korean national cardiac arrest registry.
机构信息
Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.
Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
出版信息
PLoS One. 2022 May 11;17(5):e0258673. doi: 10.1371/journal.pone.0258673. eCollection 2022.
OBJECTIVE
This study aimed to describe the relationship between sex and survival of patients with out-of-hospital cardiac arrest (OHCA) and further investigate the potential impact of female reproductive hormones on survival outcomes, by stratifying the patients into two age groups.
METHODS
This retrospective, national population-based observational, case-control study, included Korean OHCA data from January 1, 2009, to December 31, 2016. We used multiple logistic regression with propensity score-matched data. The primary outcome was survival-to-discharge.
RESULTS
Of the 94,160 patients with OHCA included, 34.2% were women. Before propensity score matching (PSM), the survival-to-discharge rate was 5.2% for females and 9.1% for males, in the entire group (OR 0.556, 95% CI [-0.526-0.588], P<0.001). In the reproductive age group (age 18-44 years), the survival-to-discharge rate was 14% for females and 15.6% for males (OR 0.879, 95% CI [0.765-1.012], P = 0,072) and in the post-menopause age group (age ≥ 55 years), the survival-to-discharge rate was 4.1% for females and 7% for males (OR 0.562, 95% CI [0.524-0.603], P<0.001). After PSM (28,577 patients of each sex), the survival-to-discharge rate was 5.4% for females and 5.4% for males (OR, 1.009 [0.938-1.085], P = 0.810). In the reproductive age group, the survival-to-discharge rate was 14.5% for females and 11.5% for males (OR 1.306, 95% CI [1.079-1.580], P = 0.006) and in the post-menopause age group, the survival-to-discharge rate was 4.2% for females and 4.6% for males (OR 0.904, 95% CI [0.828-0.986], P = 0.022). After adjustment for confounders, women of reproductive age were more likely to survive at hospital discharge. However, there was no statistically significant difference in neurological outcome (OR 1.238, 95% CI [0.979-1.566], P = 0.074).
CONCLUSIONS
Females of reproductive age had a better chance of survival when matched for confounding factors. Further studies using sex hormones are needed to improve the survival rate of patients with OHCA.
目的
本研究旨在描述院外心脏骤停（OHCA）患者的性别与生存之间的关系，并通过将患者分为两个年龄组，进一步探讨女性生殖激素对生存结局的潜在影响。
方法
这是一项回顾性的、基于全国人群的观察性病例对照研究，纳入了 2009 年 1 月 1 日至 2016 年 12 月 31 日期间韩国 OHCA 数据。我们使用了倾向评分匹配的多变量逻辑回归。主要结局是出院时的生存。
结果
在纳入的 94160 名 OHCA 患者中，34.2%为女性。在未进行倾向评分匹配（PSM）之前，整个组中女性的出院生存率为 5.2%，男性为 9.1%（OR 0.556，95%CI [-0.526-0.588]，P<0.001）。在生育年龄组（18-44 岁），女性的出院生存率为 14%，男性为 15.6%（OR 0.879，95%CI [0.765-1.012]，P=0.072），在绝经后年龄组（≥55 岁），女性的出院生存率为 4.1%，男性为 7%（OR 0.562，95%CI [0.524-0.603]，P<0.001）。在 PSM（每组 28577 名患者）后，女性的出院生存率为 5.4%，男性为 5.4%（OR，1.009 [0.938-1.085]，P=0.810）。在生育年龄组，女性的出院生存率为 14.5%，男性为 11.5%（OR 1.306，95%CI [1.079-1.580]，P=0.006），在绝经后年龄组，女性的出院生存率为 4.2%，男性为 4.6%（OR 0.904，95%CI [0.828-0.986]，P=0.022）。在调整了混杂因素后，生育年龄的女性更有可能在出院时存活。然而，神经功能结局方面没有统计学意义上的显著差异（OR 1.238，95%CI [0.979-1.566]，P=0.074）。
结论
在匹配混杂因素后，生育年龄的女性有更好的生存机会。需要进一步研究使用性激素来提高 OHCA 患者的生存率。
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